Daily Archives: 13 November, 2011

It’s really nice when medical professionals ask for patients’ input. GruntDoc asks what the ideal emergency department would look like, and wants input from a variety of people, including patients. What do you think? Here’s my two cents:

Privacy

One important issue to address is restricting access to patients. A few years ago I was in a car crash and was taken to the hospital on a back board. The paramedics unloaded me, and a million people descended. Included in all those people asking questions was one person who assured me, “Don’t worry about how to pay for this; I can get the responsible person to pay,” as he tucked a brochure for his law firm under my blanket. Ambulance-chasers aren’t a figment of Hollywood’s imagination. The emergency department should be designed to keep them out.

I have to admit that I have very little idea about my most recent trip to the ER. As my husband and I walked through the door, the person at the triage desk quickly swapped my bucket for an emesis bag and sat me down in a wheelchair. I answered a few questions, then was wheeled out into the middle of the waiting room, right in front of a lady with two little kids who were bouncing off the walls. They stopped bouncing to stage whisper, “Mommy, that lady’s throwing up.” Surprisingly, I was not bothered by a waiting room full of people watching me heave. I felt too horrible to care. When the kid made his comment, I thought, “It’s a hospital; you’re gonna see sick people here.” Although I was too sick to care, the others in the waiting room might have wished that I had a little privacy.

Testing Convenience

Both of those hospitals mentioned above have the emergency department right beside the imaging department (or maybe they have their own dedicated x-ray and CT equipment). It’s nice to not be wheeled half-way across the hospital for those tests. Likewise, it’s nice when the lab is located nearby. Those are features that would be good to incorporate into any ED.

Education

Odds are that patients who have rheumatoid arthritis will have tender joints. This includes the joints in their fingers. Everyone working in a hospital should keep that in mind if the pulse oximeter will be used. Gently placing something on the fingertip is fine. Taping the pulse-ox finger sensor onto painful fingers – using the tape as a tourniquet around one of the DIPs – is a very bad idea.

This is also true for people who have lupus, Stills, mixed connective tissue disease, juvenile arthritis, psoriatic arthritis, ankylosing spondylitis or any other form of spondyloarthropathy. Our joints already hurt, and we don’t want them assaulted by people who are supposed to be helping us. Use the gentle clip.

Entertainment

Televisions in the waiting room – just say no. The noise is annoying to people who are truly sick. Perhaps if there wasn’t free entertainment in the waiting room, people who aren’t sick would be less inclined to spend hours hanging out there.

The same thing goes for the little kids’ play area. It’s a cute idea, but ill-thought-out. If kids are sick enough that it’s an emergency, they don’t feel up to playing. If they’re not that sick, but still contagious, then they’re getting germs all over the toys. If they’re not sick at all, but accompanying a parent who couldn’t get emergency childcare, then they’re getting germs off all those toys. Now from this, you might think that I’m some ogre who hates kids. Not so. I love kids – and when they behave, I even like them. I have five children of my own, and wouldn’t dream to teaching them that the ED is a fun place to hang out. I’d rather teach them (and have others teach their children) that we only go to the hospital if it’s an emergency. No play area; no toys.

Food

Food is another issue to address in the emergency department. When I was released from the ED after my accident, the nurse offered me a sandwich. Really? I knew from looking at the clock that I’d missed supper, but the last thing I wanted to do was eat. I just wanted to go home and go to bed. Since then I’ve noticed a number of medblogs bemoaning patients who show up demanding food. Whose fault is that? Who taught people they could get free food just by going to the emergency room? Why are financially strapped hospitals giving food away?

Not everyone agrees with me. I recently read something by somebody who was complaining that the food she was given in the ER wasn’t vegetarian-friendly. She believes that needs to be addressed. I agree, but I’d address it very differently than she would.

If the cafeteria is near the ED, people who need food could easily slip into the cafeteria to buy their meal (or snack). This would solve many problems: patients get the food they need, and can choose their own menu; doctors and nurses are freed up to focus on providing medical care instead of serving as waitstaff; the hospital makes a little bit of money off of the food, instead of giving it away. The hospital might even make more money (or not lose as much by providing free, expensive care) if those looking for a handout discovered that there ain’t no such thing as a free lunch.

Refine Focus

Along those same lines, I’d address the entertainment issue not with television and germy toys, but with a gift shop conveniently located just outside the emergency department, right beside the cafeteria. The gift shop should be staffed at all times, and have plenty of newspapers, magazines, decks of playing cards, and small, quiet games for children.

People who show up in the emergency department for trivial issues take resources away from people who have real emergencies. Part of this problem could be addressed by requiring everyone to pay out-of-pocket for their food and entertainment. The ED should be designed to focus on providing high quality emergency care.